09:30am Saturday 28 March 2020

SCAI Statement on “Etiologies of Delay and Associated Mortality in Patients Transferred with ST-Elevation Myocardial Infarction” in Circulation

This study examined the reasons for treatment delays in patients who present in hospitals without cath labs and need to be transferred to a facility able to perform PCI, the life-saving procedure also known as angioplasty that is the standard of care for patients undergoing a heart attack.

The data also underscore the critical importance of effective “regional STEMI systems” – collaborative protocols among hospitals in a geographic area aimed at safely and efficiently transferring heart attack patients to PCI-capable hospitals. Proper coordination and planning have been shown to result in improvements in transfer time and better patient outcomes, and research has shown regional STEMI systems are more effective than building new cath labs to increase access to timely PCI.

“An estimated 250,000 people nationwide suffer a STEMI each year, but just 25 percent of hospitals in the United States are equipped to perform angioplasty,” said Timothy D. Henry, M.D., FSCAI, lead study author and director of research at the Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital in Minneapolis, MN.  “These new data show us is that further improvements are needed to ensure people needing transfer to these hospitals are treated in timely way.”

The study reviewed 2,034 STEMI patients transferred from 31 local non-PCI hospitals up to 210 miles away in Minnesota and Wisconsin to the Minneapolis Heart Institute from 2003 to 2009. Approximately 34 percent of the patients experienced delayed treatment, with delays most frequently occurring at the referral hospital (64 percent), the PCI center (15.7 percent) and during transport (12.6 percent). The main factors behind the 64 percent of delays at the referral hospital were caused by:

  • awaiting transportation (26 percent)
  • emergency department delays (14 percent)
  • diagnostic dilemma (9 percent)
  • initial negative test for heart attack  (9 percent)
  • cardiac arrest (6 percent)

“This information reveals where the opportunities for improvement are,” said Dr. Henry. “If we understand the causes of the delays, then we know where to concentrate our efforts going forward.” 

The findings come on the heels of another study (1) of door-to-balloon time, which showed nearly all heart attack patients who present in hospitals with cardiac cath labs are treated within the recommended 90 minutes from hospital arrival. This highlights a dramatic improvement from just five years ago, when less than half of patients suffering a heart attack were treated within the recommended 90-minute door-to-balloon time.

Previous studies have shown that when patients suffering major heart attacks undergo angioplasty within 90 minutes of their arrival at the hospital, they are much more likely to survive the event and avoid significant damage to their heart. 

“The strides we have made in improving door-to-balloon time have been staggering because it so often is the difference between life and death, or life and severely compromised quality of life,” said Christopher J. White, M.D., FSCAI, SCAI president, chairman of the Department of Cardiology and director of the Ochsner Heart and Vascular Institute in New Orleans, LA.  “Our track record with door-to-balloon time improvements shows we can address the challenges identified by this study.  The field of interventional cardiology has always been committed to quality improvement. That’s way I am confident we’ll see progress in a relatively short timeframe.”

SCAI’s commitment to ongoing improvement in door-to-balloon time efforts and quality of care is addressed through physician and patient education, among other initiatives. SCAI’s quality improvement efforts include the Cath Lab Survey Program; the Accreditation for Cardiovascular Excellence (ACE) organization, which provides professional review of facilities and accreditation for those that achieve pre-determined standards for appropriate use of procedures, quality care and continuous quality improvement; and the Quality Improvement Toolkit (SCAI-QIT), which includes customizable tools designed to support interventional cardiologists as they launch or expand quality improvement programs in their cath labs.

Through public education programs, SCAI is also addressing symptom-to-door time — the period between when patients begin experiencing heart attack symptoms until they seek treatment. The Society’s patient education website, www.SecondsCount.orgf, equips patients with information on the symptoms of a heart attack and the importance of promptly seeking emergency care. SCAI also hosts educational programs throughout the country for cardiovascular patients and others concerned about heart disease. At SCAI’s “Know What Counts” programs, attendees learn about heart disease symptoms as well as diagnostic and treatment options, questions to ask their doctors, and strategies for prevention. Know What Counts programs are held throughout the United States, often in partnership with patient advocacy groups and other professional medical societies. 


  1. Krumholz H, Herrin J, Miller L, et al. Improvements in door-to-balloon time in the United States 2005 to 2010. Circulation 2011; DOI:10.1161/CIRCULATIONAHA.111.044107. Available at: http://circ.ahajournals.org.

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